Protect Revenue Through Proactive Compliance Audits

Over the past six months, in our own client work and published settlements, it is evident that the Department of Justice (“DOJ”) is continuing to focus its audit efforts on patient status. Most recently, a Houston-based health system agreed to pay $1.9 million to resolve allegations that three of its hospitals improperly billed Medicare for inpatient services that the DOJ deemed should have been billed as outpatient care. In our Revenue Integrity Audit work, we are seeing more probes into patient status and medical necessity denials in this area.

As budgets tighten and the pressure increases from the government, healthcare organizations need to proactively ensure the compliance of their coding and documentation. What steps can you take?